To assess the outcomes of high-dose-rate (HDR) brachytherapy and hypofractionated external beam radiation therapy (EBRT) combined with long-term androgen deprivation therapy (ADT) in very-high-risk (VHR) versus high-risk (HR) prostate cancer (PCa), as defined in the National Comprehensive Cancer Network (NCCN) criteria.
Data from 338 consecutive HR or VHR PCa patients who had undergone this tri-modal therapy between 2005 and 2018 were retrospectively analyzed. Biochemical recurrence (BCR)-free, progression-free, overall, and cancer-specific survival (BCRFS/PFS/OS/CSS) rates were analyzed using the Kaplan-Meier method and Wilcoxon test. Cox regression models were used to evaluate candidate prognostic factors for survival. C‑indexes were used to assess model discrimination.
Within a median follow-up of 84 months, 68 patients experienced BCR, 58 had disease progression including only 3 with local progression, 27 died of any cause, and 2 died from PCa. The 5‑year BCRFS, PFS, OS, and CSS rates were 82.2% (HR 86.5%; VHR 70.0%), 90.0% (HR 94.3%; VHR 77.6%), 95.7% (HR, 97.1%; VHR, 91.8%), and 99.6% (HR, 100%; VHR, 98.0%), respectively. In multivariable analyses that adjusted for standard clinicopathologic features, the risk subclassification was associated both PFS and OS (p = 0.0003 and 0.001, respectively). Adding the risk subclassification improved the accuracy of models in predicting BCRFS, PFS, and OS.
While the outcome of this trimodal approach appears favorable, VHR PCa patients had significantly worse oncological outcomes than those with HR PCa. The NCCN risk subclassification should be integrated into prognostic tools to guide risk stratification, treatment, and follow-up for unfavorable PCa patients receiving this trimodal therapy.
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]. 2021 Apr 28 [Epub ahead of print]
Keiichiro Mori, Hiroshi Sasaki, Yuki Tsutsumi, Shun Sato, Yuki Takiguchi, Shun Saito, Eriko Nishi, Gen Ishii, Toshihiro Yamamoto, Yusuke Koike, Jun Miki, Tatsuya Shimomura, Takahiro Kimura, Kenta Miki, Shahrokh F Shariat, Hiroyuki Takahashi, Manabu Aoki, Shin Egawa
Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan. ., Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan., Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan., Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Medical University of Vienna, Vienna, Austria.